To AR1281A, RE: Adrenal Insufficiency

[Jimlow]

AR, I actually intended to try getting with you on this subject, so am glad you suggested it. I hope we might have some input for eachother. If I go too long, I'll post a Part II below this one. When I was Dx'ed hypo, my readings according to the Doc, were only "subclinical", with a TSH of "8.3" and a T-3 Uptake flagged "low". The rest of my thyroids were in lower half of normal. It wasn't until two years later I got the antibodies one and my TG ABs were "537" (normal being <40)and my TPO ABs were "84" (normal being <35), so this was the test that actually confirmed Hashimoto's. ANYWAY, here was my problem from the beginning; After I started my thyroid med., some of my symptoms actually WORSENED. I was frustrated, so did a search using "Worse symptoms after starting thyroid replacement medication" (or something like that) and it took me to sites stating; If you have UNTREATED adrenal insufficiency, this can worsen if you start thyroid medication. This was also stated on the thyroid brands websites! I decided I would get checked for "cortisol" levels, it being the "major stress hormone" that regulates glucose! I searched and found "Great Smokies Diagnostic Labratories", who put out BodyBalance Brand, home saliva tests to check DHEA/Cortisol levels. These are as acurate as blood tests! My DHEA was about mid-range but my cortisol on 4-different ones of these I took over a year period, were all either low-normal, borderline low and one was clinically low. I then found another company that sets up testing for LabOne and got a 24-hour urine cortisol test done.
CONTINUED>>>

[Jimlow]

The range on it was <119 for males age-18 and older, mine was "10.7"! I finally made it to an actual Dr. visit and showed him these readings. As I suspected, he patronized me but went ahead and sent me for an "ACTH Stimulation Test" (Expensive!). I was VERY ANXIOUS when I had it done, which probably gave a falsely high "baseline level". They first get your baseline or starting level, then inject you with ACTH, the hormone, stimulates your adrenals to produce cortisol, then they recheck at 30-min and 1-hour. My baseline was "10.7", my 30-min was "25.7" and my 1-hour was "37.4". SO, I passed the stimulation of my adrenals real well BUT this DID NOT change the fact that my cortsol levels are low, without stimulation! My guess is that Imay be low on the ACTH hormone. Haven't been checked for the level of that particular homone. I have also thought about being checked for "adrenal antibodies" levels, to see if I am early into an autoimmune attack. I hope I am not but there is some reason for my low adrenal output of cortisol! My symptoms have been; orthostatic hypotension (severe dizziness/pressure in head when standing) slow resting heartbeat, low resting blood pressure, fatigue, joint pain, post exertional fatigue (after physical activity) etc... which I have attributed much of, to thyroid but sometimes wonder if it is the adrenals! I do KNOW FOR A FACT, some of this worsened with thyroid med but I need it or risk worse hypo symptoms!
Get back to me AR, let's see if we can get to some answers together on this thing. It has been a battle! THANKS

[Jimlow]

Ar, I forgot to add to that second one that there is a condition just plain called; "Adrenal Fatigue" and "Adrenal Exhaustion" but 99.9% of Dr.s do not believe it exists! they only recognize "Addison's Disease", the most severe type of adrenal insufficiency! Addison's means you are on the edge of going into a "crises" meaning coma etc... It's funny how they recognize different levels of thyroid disfunction but with adrenals, it's ALL OR NOTHING. All I know is my low cortisol levels have been consistant.
They do make "Adrenal Support" (over-the-counter)products out there but I am reluctant to try them in case they interact in the wrong way with my thyroid medication.

[ar1281a]

JimLow, thanks for such a great response!!!!
Actually went to my endo yesterday, she checked all my blood (including Thyroid) and sent for an antibody test of the adrenal glands. There are other tests she said she couldn't do as they have me on prednisone after the relapse I had last week after the allergic reaction. This morning she called saying that all blood work looked fine, TSH is 0.76 and T3 and T4 look good too. Antobodies test need to wait a little longer but she really hopes I don't have that. In the meantime, I continue to feel awful, I know that my blood pressure greatly fluctuates during the day and can barely walk three steps without feeling I'm fainting. My primary has refrred me to the allergist to see if my body is still reacting or just needs time to re-adjust after the allergic reaction. I really need to feel better, I can't continue like this. Another possibility is that the allergic reaction may had somehow, produced some imbalance in my adrenal glands production, but if this is the case I shouldn't be feeling bad as I'm on prednisone and it should replacing whatever my glands are failing to produce...so, I'm right at the beginning, I think. Unsure at what's wrong with me and not feeling a bit better.

[Jimlow]

Ar,
I mentioned Chronic Fatigue Syndrome and Fibrmyalgia and I am not at all saying you have either of these but am just bringing them up as examples of different types of adrenal insufficiecies that exist out there and they always seem tied somehow into thyroid function. Another "Axis" I hear them refer to is the "thyroid-Adrenal Axis".
Here's a couple more interesting facts in that area; The National Institutes of Health (Allergies & Infectious Diseases Dept), did a study on CFS in 1996 and they state in their Embargoed Release; "CFS Patients had slightly lower levels of cirulating cortisol...than healthy individuals". They also said; "Doctors have long known that even subtle deficiencies in cortisol can be associated with lethargy and fatigue". They also said; "...low cortisol levels in the CFS patients MIGHT be due to deficiencies in cortitropin-releasing-hormone (CRH), a brain chemical that helps regulate cortisol secretion." (NOTE: CRH is not the same as ACTH and they don't have a test for it).

Another Dept. of the National Institutes of Health (Arthritis, Musculoskeletal and Skin Diseases Dept.), found the same research results with Fibromyalgia and they stated; "...low levels of the hormone cortisol may be associated with fibromyalgia."  They also said; "People whose bodies make inadequate amounts of cortisol experience the same symptoms as people with fibromyalgia."
What I am leaning toward in my understanding of these researches, is that some people with CFS and FM type symptoms may have a sub-clinical form of adrenal insufficiency.
Did you guys know that Pres. John F. Kennedy, developed adrenal insufficiency after being shot down, as a fighter pilot in WWII? He was put on replacement homone from that point on. Some people can experience a severe stressor and causes adrenal insufficiency. Many people with CFS & FM, report they had a viral illness that seemed to trigger it, similar to severe allergic reaction.
There is so much info. and some may be good and some not, because at times it seems to contradict but, there was research basis for all of it. My belief is that thyroid disease (autoimmune), both Graves and Hashimoto's POSSIBLY triggers this same type adrenal problem. This is only my opinion but AR, please let me know how your adrenal antibodies test comes out, I already asked Shanon, to let me know. I will likely get that one myself!